Metabolic outcomes in the first year after laparoscopic sleeve gastrectomy: a high-volume single-center experience.

OBJECTIVE: Laparoscopic sleeve gastrectomy (LSG) is the most preferred bariatric surgical procedure worldwide. LSG, a restrictive surgical method, has also proven to be a good metabolic surgery option. In this study, we examined weight loss and changes in metabolic parameters in our patients in the first year after LSG. PATIENTS AND METHODS: In this retrospective cohort study, preoperative and postoperative first-year body mass index (BMI) changes, biochemical and hormonal analysis results, and excess weight loss (EWL) rates of 1,137 patients who underwent LSG were evaluated. RESULTS: The median age of patients undergoing LSG was 39 years, and 943 (82.9%) of the patients were female while 194 (17.1%) were male. Preoperative BMI was 45.91 kg/m2 and postoperative first-year BMI was 28.98 kg/m2 (p<0.01). Fasting blood glucose, alanine aminotransferase, aspartate aminotransferase, total cholesterol, triglycerides, insulin, free thyroxine, thyroid-stimulating hormone, and HbA1c percentage levels were significantly low in the postoperative first year (p<0.001). EWL was 81.0% (68.4-97.9%) and sufficient weight loss (SWL; ≥50% of EWL) was 92.2% in the postoperative first year. Median age, the prevalence of type 2 diabetes mellitus, preoperative fasting plasma glucose levels, and preoperative triglyceride levels were higher in the SWL group than they were in the group with insufficient weight loss (EWL of <50%). Factors such as male sex, body weight, and triglyceride levels were positively correlated with adequate weight loss, while BMI and total cholesterol levels were negatively correlated with adequate weight loss. Patients with BMI of >46.87 kg/m2 had a higher rate of adequate weight loss. CONCLUSIONS: LSG is a bariatric surgical procedure providing satisfactory weight loss and metabolic outcomes in the short term. Weight loss success in the first year after LSG was higher among patients with a baseline BMI of 46 kg/m2.

Predictive value of immature granulocyte and delta neutrophil index in the diagnosis of complicated acute cholecystitis.

OBJECTIVE: The complicated gallbladder disorders are associated with increased mortality and morbidity. Thus, this study was aimed at evaluating the predictive value of immature granulocyte count and delta neutrophil index in the prediction of complicated cholecystitis. PATIENTS AND METHODS: We retrospectively reviewed patients who underwent surgery for acute cholecystitis between January 2018 and April 2022. Overall, 351 patients fulfilling the inclusion criteria were included in the study. In all patients, demographic data, immature granulocyte count (IGC), delta neutrophil index (DNI), white blood cell (WBC) count, C-reactive protein (CRP), and albumin levels were recorded. Based on operative findings and histopathological examination, the patients were classified into 2 groups uncomplicated (group I) and complicated (e.g., perforation, gangrenous and emphysematous cholecystitis; group II) groups. The IBM SPSS version 26.0 (SPSS Corp, Armonk, NY, USA) was used to assess differences in blood parameters between groups. The predictive values of the parameters evaluated were estimated using ROC analysis. A p-value<0.05 was considered statistically significant. RESULTS: Acute complicated cholecystitis was found in 138 of 351 patients. No significant difference was detected in age and gender distribution between groups (p=0.352 and p=0.214, respectively). When blood parameters were assessed, it was found that IGC, DNI, WBC, and CAR values were significantly higher in group II (p<0.001; p<0.001, p<0.001, and p=0.036, respectively), while there was no significant difference in CRP and albumin between groups (p=0.099 and p=0.53, respectively). In the ROC analysis, the highest AUC value was found for IG count and DNI (0.784 and 0.775, respectively). The sensitivity and specificity were found as 68.8% and 86.9% for IG count and 49.3% and 96.2% for DNI, respectively. CONCLUSIONS: The IG count and DNI are two novel parameters with strong predictive value in the early diagnosis of acute complicated cholecystitis, which may support clinical findings, imaging studies, and other laboratory parameters.

Can serum basal cortisol values predict successful operations for bariatric surgery patients?

OBJECTIVE: Obesity is a chronic metabolic disease declared as the 21st century pandemic by the World Health Organization. Obesity has become an alarming situation for society, and it has to be treated. If the appropriate criteria are met by patients, bariatric surgery is an effective treatment method that provides weight loss in a short time. There are no definitive criteria regarding which groups of patients and characteristics may benefit most from bariatric surgery. In this study, we evaluate whether serum basal cortisol levels can predict successful outcomes of bariatric surgery and whether there is any difference in outcome between diabetic and non-diabetic patients. PATIENTS AND METHODS: This observational study included 244 obese patients who had undergone laparoscopic sleeve gastrectomy (LSG). Preoperative and postoperative 6-month weight, body mass index (BMI), serum basal cortisol, fasting plasma glucose, 1-mg dexamethasone suppression test (DST) results, and Type 2 Diabetes Mellitus (T2D) history were recorded. We analyzed the patients first by dividing them into two groups as excessive weight loss (%EWL) ≥50% and %EWL< 50%, and then into two groups as diabetic and nondiabetic patients. RESULTS: The mean age of patients with %EWL≥ 50% was found to be statistically significantly lower than that of patients with %EWL< 50% [39 (19-60) vs. 47 (36-61) years; p=0.046]. While there was no significant difference in basal cortisol values (p=0.513), DST results were statistically significantly lower in patients with %EWL≥ 50% than patients with %EWL< 50% [0.6 (0.1-2.1) vs. 0.8 (0.7-1.1); p=0.040]. CONCLUSIONS: In obese patients undergoing LSG, serum basal cortisol level may not predict the success of operation. However, the result of 1 mg DST may predict the operation success.

Expression of CYP and GST in human normal and colon tumor tissues.

We investigated the immunohistochemical staining characteristics of cytochrome P450 1A1 (CYP1A1), CYPB1, CYP2E1, and glutathione S-transferase P1 (GSTP1), GSTT1, GSTO1, GSTK1 in colon tumor and surrounding normal colon tissues. Tissues were obtained from 47 patients with colon adenocarcinoma and the staining intensity of tumor and control tissues was compared. CYP1A1, CYP1B1, CYP2E1, GSTP1, GSTT1, GSTO1 and GSTK1 expressions in colon cancer cells were significantly greater than those in normal colon epithelial cells. No significant relation was found between the isoenzyme expressions and age, gender, smoking status, tumor grade and tumor stage. The higher expressions of CYP1A1, CYP1B1, CYP2E1, GSTP1, GSTO1, GSTT1 and GSTK1 in tumor than in normal colon tissues may be important for colon cancer progression and development.

The postoperative analgesic efficacy of intraperitoneal bupivacaine compared with levobupivacaine in laparoscopic cholecystectomy.

BACKGROUND: The aim of this randomized controlled study was to compare the postoperative analgesic efficacy of intraperitoneal bupivacaine versus levobupivacaine in patients undergoing laparoscopic cholecystectomy. METHODS: We randomly divided 90 patients undergoing elective laparoscopic cholecystectomy into 3 groups. A dose of 0.125% bupivacaine (Group B) 80 ml or 0.125% levobupivacaine (Group L) 80 ml or 0.09% NaCl (Group P) 80 ml was instilled intraperitoneally at the end of the procedure, before removal of the trocars. All patients had a standard anesthetic. Tramadol was administered intravenously via a patient controlled analgesia pump as a rescue analgesic in all patients. Postoperative pain scores were assessed at 30 minutes, 1, 2, 4, 6, 12 and 24 hours after surgery by using a visual analog scale. The primary end point of this study was to compare tramadol consumption of the three groups at the postoperative 24 h. Total tramadol consumption, first analgesic requirement time and adverse effects were recorded. RESULTS: Group B experienced significantly less pain (P < 0.01) than the placebo group at 6 h, 12 h and 24 h postoperatively during rest. Group L registered significantly lower visual analog scale scores (p < 0.01) than the placebo group at 12 h during rest. During movement, visual analog scale pain scores were lower in group B than Group P (P < 0.01). Additionally, total tramadol consumption was significantly lower in Group B than the other groups. First analgesic requirement time was shorter in the placebo group compared with group B and group L (P < 0.05). There was no significant difference between the groups with respect to right shoulder pain, total nausea and vomiting. CONCLUSION: Intraperitoneal instillation of bupivacaine 0.125% 80 ml (100 mg) is more effective than levobupivacaine 0.125% 80 ml (100 mg) in reducing the postoperative pain after laparoscopic cholecystectomy.

Evaluation of three instruments for laparoscopic cholecystectomy: harmonic scalpel, bipolar vessel sealer, and conventional technique.

AIM: Laparoscopy is the gold standard procedure in the surgery of gall bladder. Harmonic scalpel and bipolar vessel sealer are the other instruments for laparoscopic cholecystectomy. The aim of this study is to compare the effectiveness and safety of the three instruments for laparoscopic cholecystectomy. METHODS: A total of 60 patients were included into the study. Patients were divided into three groups. In Group A, cystic duct and artery were sealed using laparoscopic clips and gall bladder was dissected from the hepatic bed using electrocautery. In Group B, cystic duct and artery were sealed using Harmonic scalpel and gall bladder was dissected from the hepatic bed using Harmonic scalpel. In Group C, cystic duct and artery were sealed using Bipolar vessel sealer and gall bladder was dissected from the hepatic bed using Bipolar vessel sealer. Groups were compared for the following parameters: duration of surgery, amount of drainage, cystic duct opening pressure and cost. RESULTS: The duration of surgery was 31.5 ± 11.1 minutes in Group B, 33.1 ± 10 minutes in Group A, and 36.5 ± 9.9 in Group C; and the difference between Group B and Group C was statistically significant (P<0.04). Cystic duct opening pressure was highest in Group A which was 324.0 ± 23.4 mmHg. For all of these 3 groups total cost was found to be 900$, 2900$, 1800$ for groups A, B, and C; respectively. CONCLUSION: In laparoscopic cholecystectomy different energy source instruments may be safe to use with a cautious dissection and sealing of the cystic duct.

Comparison of laparoscopic and open adrenalectomy.

UNLABELLED: Laparoscopic adrenalectomy is one of the most significant advances in the past 20 years for treating adrenal disorders. Laparoscopic adrenalectomy has been the golden standard procedure for all adrenal pathologies since it was first defined in 1992. Laparoscopic adrenalectomy is preferred and has advantages such as less postoperative pain, earlier resumption of oral intake, shorter hospital stay, earlier return to normal life and better esthetical results. In our study we compared morbidity and mortality rates of laparoscopic and open adrenalectomy cases. MATERIAL AND METHODS: In Ankara University Faculty of Medicine General Surgery department 92 cases of adrenalectomy were performed between january 2000-july 2006. The patients were evaluated for age, sex, duration of perioperative hospital stay, resumption of oral intake, duration of operation, surgical wound infection, conversion rate and complications. RESULTS: In patients who underwent laparoscopic surgery, rate of conversion to open surgery was 9.3% (4 patients). The mean operative duration in the laparoscopic adrenalectomy group was 150 minutes and the mean operative duration in the open adrenalectomy group was 120 minutes (p = 0.001). Surgical wound infection rate was 6% in the open adrenalectomy group and 2% in the laparoscopic adrenalectomy group. Mean perioperative hospital stay was 7.1 days in the open adrenalectomy group and 5.1 days in the laparoscopic adrenalectomy group. Time to resumption of oral intake was 2.42 days in the open adrenalectomy group and 1.05 days in the laparoscopic adrenalectomy group (p = 0.001). There was no perioperative mortality in none of the groups. CONCLUSION: Laparoscopic adrenalectomy is the golden standard surgical treatment for benign and selected malignant adrenal diseases. Laparoscopic adrenalectomy is a safe and effective technique and has advantages such as less postoperative pain, earlier resumption to oral intake, shorter hospital stay, earlier return to normal life and better esthetical results compared to open adrenalectomy.